Men who use cannabis are twice as likely to experience erectile dysfunction (ED) than those who do not, according to a new systematic and meta-analysis published in the American Journal of Men’s Health.

In 5 case-control studies of “good” quality involving 3395 healthy men, 1035 disclosed cannabis smoking. In this group, 69.1% of cannabis smokers versus 34.7% of nonusers reported ED on the International Index of Erectile Function-5 questionnaire. In a meta-analysis, cannabis smokers had nearly quadruple the risk for ED compared with nonusers, lead researcher Damiano Pizzol, MD, PhD, of the Italian Agency for Development Cooperation in Jerusalem, Israel, and colleagues stated.

In an interview with Renal & Urology News, Dr Pizzol said, “Understanding emerging risk factors for ED, particularly in relation to the increasing legalization of cannabis, is highly important. Approximately 147 million people — 2.5% of the world’s population — consumes cannabis annually. Although no medical specialty is dedicated to monitoring cannabis use and abuse, we believe urologists should make all male patients aware of the associated risk of ED.”

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Among the possible mechanisms, cannabis smoking may bind receptors in the paraventricular nucleus of the hypothalamus which regulates erectile function, Dr Pizzol’s team explained. This mechanism could also explain why cannabis can improve sexual function in some patients affected by depression, anxiety, or pain, the authors noted. Other research suggests a peripheral effect of cannabis smoking on the cannabinoid receptors of the corpus cavernosum.

Most of the studies did not report the type, potency, and frequency of cannabis smoked, which is a limitation.

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Pizzol D, Demurtas J, Stubbs B, et al. Relationship between cannabis use and erectile dysfunction: A systematic review and meta-analysis. Am J Men’s Health. November-December 2019: 1–7. doi:10.1177/1557988319892464